Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2403
Peer-review started: February 26, 2020
First decision: April 2, 2020
Revised: April 9, 2020
Accepted: May 1, 2020
Article in press: May 1, 2020
Published online: May 21, 2020
Processing time: 84 Days and 23.9 Hours
Different types of periampullary diverticulum (PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation, but the clinical significance of the two current PAD classifications for cannulation is limited.
To verify the clinical value of our newly proposed PAD classification.
A new PAD classification (Li-Tanaka classification) was proposed at our center. All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.
A total of 3564 patients with native papillae were enrolled, including 967 (27.13%) PAD patients and 2597 (72.87%) non-PAD patients. In the Li-Tanaka classification, type I PAD patients exhibited the highest difficult cannulation rate (23.1%, P = 0.01), and type II and IV patients had the highest cannulation success rates (99.4% in type II and 99.3% in type IV, P < 0.001). In a multivariable-adjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio (OR) = 1.87, 95% confidence interval (CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group, the difficulty of cannulation in the type I PAD group according to the Li-Tanaka classification was greater (OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower (OR = 0.27, 95%CI: 0.11-0.66, P < 0.001), while it was higher in the type II PAD group (OR = 4.44, 95%CI: 1.61-12.29, P < 0.01).
Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.
Core tip: Unlike previous studies conducted more than a decade ago, most current studies no longer suggest that periampullary diverticulum (PAD) significantly increases the difficulty of cannulation. However, we found that different clinical types of PAD may affect the difficulty and even success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation. Furthermore, existing PAD classifications have limited clinical guidance value. We proposed a new PAD classification method (Li-Tanaka classification) in 2012 based on the number of PADs and their anatomical relationship with the major papilla, and we conducted a retrospective study to evaluate the clinical value of the Li-Tanaka PAD classification for ERCP cannulation. Our study showed that the Li-Tanaka classification has good clinical significance for ERCP cannulation.